Nursing Elites

1. The client diagnosed with diabetes mellitus type 2 is admitted to the hospital with cellulitis of the right foot secondary to an insect bite. Which intervention should the nurse implement first?

• A. Administer intravenous antibiotics
• B. Apply warm moist packs every two hours
• C. Elevate the right foot on two pillows
• D. Teach the client about skin and foot care

Correct answer: A

Rationale: Administering intravenous antibiotics is the priority intervention in this scenario. Cellulitis is a bacterial skin infection that requires prompt treatment with antibiotics to prevent its spread and potential complications. While warm moist packs and elevation can be beneficial as adjunct measures, they are not the initial priority. Teaching about skin and foot care is important, but it can be addressed after stabilizing the acute condition with antibiotics.

2. Under the health services support area concept, how is the medical care under the MEDCOM divided?

• A. Six geographical regions of the United States with command authority in each region
• B. Five levels of health service support, each providing different levels of health care services
• C. Primary and secondary health care regions, each containing a MEDDAC or MEDCEN
• D. Eight geographical areas of responsibility designated as health services support regions, each of which is subdivided into two or more health service areas

Correct answer: D

Rationale: The correct answer is D. Under the health services support area concept, the medical care under the MEDCOM is divided into eight geographical areas of responsibility designated as health services support regions, each of which is further subdivided into two or more health service areas. This structure allows for a more organized and efficient delivery of medical care across different regions. Choices A, B, and C are incorrect because they do not accurately describe how medical care under the MEDCOM is divided according to the concept of health services support areas.

3. The unlicensed nursing assistant is applying elastic compression stockings to the client. Which action by the assistant warrants immediate intervention by the nurse?

• A. The assistant is putting the stockings on while the client is in the chair.
• B. The assistant inserted two (2) fingers under the proximal end of the stocking.
• C. The assistant elevated the feet while lying down to put on the stockings.
• D. The assistant made sure the toes were warm after putting the stockings on.

Correct answer: A

Rationale: The correct answer is A because compression stockings should be applied while the client is lying down to prevent pooling of blood in the legs, which can occur when the client is sitting or standing. Choice B is not a cause for immediate intervention as inserting two fingers under the proximal end of the stocking helps ensure proper fit. Choice C demonstrates the correct technique of elevating the feet while lying down to put on the stockings. Choice D also shows good care by making sure the toes were warm after putting the stockings on.

4. The nurse is analyzing laboratory values for the assigned clients. Which finding, based on the client's medical history, indicates the need for immediate follow-up?

• A. Client with chronic kidney disease and serum creatinine of 1.6 mg/dL
• B. Client with diabetes mellitus and a glycosylated hemoglobin A1c (HbA1c) of 7.0%
• C. Client with heart failure and a B-type natriuretic peptide (BNP) of 140 pg/mL
• D. Client who is male and has anemia with hemoglobin of 16.5 g/dL and hematocrit of 45%

Correct answer: B

Rationale: An HbA1c of 7.0% in a client with diabetes mellitus indicates poor long-term glucose control, necessitating immediate follow-up. Choice A, chronic kidney disease with a serum creatinine of 1.6 mg/dL, though concerning, does not indicate an immediate need for follow-up. Choice C, heart failure with a BNP of 140 pg/mL, may require monitoring but not immediate follow-up. Choice D, a male client with anemia and normal hemoglobin and hematocrit levels, does not warrant immediate attention based on the provided information.

5. The client is four hours post-operative abdominal aortic aneurysm repair. Which nursing intervention should be implemented for this client?

• A. Assist the client in ambulating
• B. Assess the client’s bilateral pedal pulses
• C. Maintain a continuous IV heparin drip
• D. Provide clear liquids to the client

Correct answer: B

Rationale: Assessing the client’s bilateral pedal pulses is crucial at this point to monitor the perfusion to the lower extremities after abdominal aortic aneurysm repair surgery. Ambulation (Choice A) may be appropriate but should be guided by the assessment findings. Maintaining a continuous IV heparin drip (Choice C) is not typically indicated post-operatively for this type of surgery. Providing clear liquids (Choice D) may not be suitable immediately after the surgery, as the client needs time to recover before resuming oral intake.

Similar Questions